Nearly 40 years after the passage of Medicare and Medicaid, a new report released Tuesday examines America's long-term care services, funding and costs, and how public policy can lead to improvements.

"The Realist's Guide to Medicaid and Long-Term Care," from the Center for Long-Term Care Financing, discusses the quality and funding problems long-term care faces. It also lists the five best and five worst states in terms of long-term care policy and advocates a more aggressive push for reverse mortgages.

The report was co-sponsored by the Council for Affordable Health Insurance and the American Legislative Exchange Council co-sponsored the study. Financing for the report came from Equitable Life & Casualty. Blue Cross and Blue Shield of Alabama, New York Life Insurance Co., and Milbank Foundation for Rehabilitation.

The report focuses on bankruptcy, quality problems and exploding Medicaid costs that have made long-term care more expensive and less accessible for Americans, authors say. Public policy change can control costs and improve access to quality long-term care, according to the report.

The Center for Long-Term Care Financing calls itself a nonprofit think tank and public policy organization.